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NEW YORK — Ten issues will take center stage as the healthcare industry moves to meet the requirements of the Patient Protection and Affordable Care Act, according to a new report by PricewaterhouseCoopers.
The report found that the pace will likely quicken this year due to technology, consumerism, budgetary pressures and the healthcare reform law converging on the sector, which represents one-fifth of the U.S. economy. To assemble the report, PwC's Health Research Institute collected input from PwC Health Industries professionals who work with hospitals, physician groups, drug and device companies and employers, in addition to polling 1,000 U.S. consumers.
"Health organizations can hear the thundering footsteps of 30 million newly insured Americans on the horizon," PwC U.S. health industries leader Kelly Barnes said. "By this time next year, the major provisions of the health-reform law will be in effect, and the health industry has a lot of work to do before then. It's now a foot race to 2014. The evolution of health care that has been in effect over the past several years will become a full-scale transformation in 2013."
The top 10 issues facing the industry, PwC said, are:
States are on the front lines of Affordable Care Act implementation
State officials will have to decide over the next year how to run insurance exchanges, whether to expand Medicaid coverage and what type of insurance market regulation is needed as information technology and the question of how to create a single, seamless entry point to the exchange will present a challenge.
Revolution in health coverage
The report found that nearly one-quarter of surveyed consumers said they were likely to buy health insurance from nontraditional sources, such as a retail store, up from 18% in 2011. Meanwhile, consumers' rising voice on how they spend their healthcare money and state insurance exchanges are prompting the health industry to compete on attributes similar to the retail industry — namely price, convenience and transparency.
Medical technology industry braces for excise tax impact
A 2.3% excise tax on medical device companies took effect on Jan. 1, which could represent $29.1 billion for the federal government over the next 10 years. The industry is unlikely to be able to pass the tax on to consumers, however.
Caring for dual eligibles
Often considered the most vulnerable patients, dual eligibles are those patients who qualify for both Medicare and Medicaid, making up many of the 16 million people the Affordable Care Act who will add to Medicaid rolls by 2019. Lack of care coordination between the two programs leads to "skyrocketing" costs due to waste, and 70% of state Medicaid spending on these patients goes to long-term care. The result is that states are increasingly turning to managed care companies to better coordinate care and seeking innovative solutions.
Convenience of mobile may come at a cost
While doctors and nurses are bringing their own mobile devices to work, many hospitals don't yet have a secure enough environment to protect sensitive patient information, and 69% of surveyed consumers said they were concerned about the privacy of medical information if providers can access it on mobile devices, and only 46% of hospitals have a security strategy to regulate the use of mobile devices.
Cost reduction is down, while transformation is up
Hospitals are scrambling to reduce their costs due to reimbursement reseting under the healthcare-reform law and pressure from the federal budget crisis and price-conscious consumers. According to the report, 40% of consumers postponed care in 2012 because of costs.
Customer ratings hit the pocketbooks of healthcare companies
Paying for performance will take on new meaning in 2013 as consumer reviews generate penalties and bonuses for hospitals and insurers. This could mean a bonus payout of more than $3 billion for insurers and a hold back of $850 million for providers this year.
Meeting the new expectations of pharma value
Physicians now have less say in patient decisions than insurers and large providers, while reimbursement has replaced regulatory approval as the final hurdle in the path to drug and device development. Drug and medical device companies will have to prove their worth in health outcomes by demonstrating value and comparative effectiveness.
Employers rethink their healthcare role
Employer-based coverage has been a cornerstone of U.S. healthcare for nearly 70 years, but the two may not be inseparable. With the Supreme Court's decision to uphold the Affordable Care Act and President Barack Obama's re-election, employers may be able to explore alternative approaches provided by state and private exchanges.
The building blocks of population health management
Medicare's accountable care organization and patient-centered medical home initiatives laid a foundation for improving population health, but other collaborations are fueling growth in population health management. More companies this year are likely to form partnerships to build their population health information technology infrastructures and share responsibility for patient outcomes and satisfaction, data collection and analysis, member education and engagement with a focus on at-risk populations.